Inspection·November 14, 2023

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few understands others. She had severe cognitive impairment (BIMS score of 5). She had hallucinations and delusions. There were no behaviors directed at others. Record review of progress note dated 10/31/23 at 1:50 p.m., completed by LVN E (MDS) indicated Resident #1 was on secure unit. She was hitting, slapping, and pinching staff. LVN E spoke with staff at behavior hospital who said Resident #1 was at base line of needing one on one care with aggressive behaviors. The physician was notified and waiting for orders. Record review of a progress noted dated 11/03/23 at 7:29 p.m., completed by LVN A indicated Resident #1 attempted to pull walker away from Resident #2. Resident #1 hit Resident #2 on the top of her left hand, on her left wrist, and on the left side of her face. Resident #1 separated from Resident #2 and monitored one on one. Record review of a progress note dated 11/03/23 at 11:45 p.m., completed by LVN B indicated Resident #1's family member was notified of Resident #1's behaviors. Resident #1 was transported by the facility and discharged home at approximately 11:30 p.m. Record review of Resident #1's incident report dated 11/03/23 at 11:00 p.m. , completed by LVN A indicated Resident #1 attempted to pull Resident #2's walker away from her. When Resident #1 was not able to pull the walker away from Resident #2, Resident #1 hit Resident #2 on the top of her left hand, on her left wrist, and on the left side of her face. CNA C walked into the dining room while Resident #1 and Resident #2 were standing close together with arms locked. CNA C separated Resident #1 and Resident #2. Resident #2 hit CNA C. Residents #1 and Resident #2 were separated. Resident #1 placed on one to one monitoring. The DON, Administrator, RP, and MD were notified. Hospice was notified. There were no observed injuries. Record review of Resident #2's incident report dated 11/11/23 at 11:00 p.m., completed by LVN A indicated Resident #2 was hit on her left hand, left wrist, and left side of her face. Resident #2 said, She hit me. Did you see her? Resident #2 was grabbed on her left wrist by Resident #1. Unable to determine how hard Resident #2 was grabbed. Resident #1 had both hands wrapped around Resident #1's wrist and was twisting Resident #2's hands back and forth while grabbing Resident #1's left wrist. Resident #1 and Resident #2 were separated. Resident #2 denied any pain. No distress noted. No bruising, [NAME], discoloration, or anything abnormal noted to Resident #2's left hand, wrist or face. No signs of pain noted upon passive ROM to LUE. Physician, DON, Administrator, and guardian notified. Record review of CNA C's statement dated 11/08/23 indicated she was returning to the dayroom of the secure unit when she saw Resident #1 gripping Resident #2's arm. CNA C intervened and pried Resident #1's hand off of Resident #2. Resident #2 proceeded to attack CNA C. One on One was implemented on the other side of the day room. CNA C reported the incident to the charge nurse immediately. The surveyor requested to observe the video of the incident on 11/03/23. The facility was not able to provide access to the video because the system did not retain a copy. During an interview on 11/11/23 at 9:35 a.m., the Administrator said she was the abuse coordinator. She said Resident #1 resided on the secure unit. She said Resident #1 had a history of aggression towards staff and residents. She said the other residents were afraid of Resident #1. She said there were two CNAs on the secure unit when the incident occurred. She said staff were supposed to supervise and monitor Resident #1 but left her alone to provide care for another resident. Staff should have called for the nurse to provide the supervision when they were not able to supervise Resident #1. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676072 If continuation sheet Page 2 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676072 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corrigan Ltc Nursing & Rehabilitation 300 Hyde St Corrigan, TX 75939 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few She said all staff were at risk of abuse from Resident #1 when there was no supervision. She said after the incident with Resident #1 on 11/03/23, the facility held a QAPI on 11/08/23 and developed PIPs related to preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors. She said the facility started retraining nursing staff on 11/03/23. She said all nursing staff were retrained on preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors. She said all new staff and any staff not trained were trained by the DON or ADON prior to working their scheduled shift. She said there were no other residents in the facility who were abusive to other residents. She said she (the Administrator) and the DON were responsible to ensure all staff were trained and to monitor to ensure compliance with the QAPI plan/PIP. During observation and interview on 11/11/23 at 10:25 a.m., Resident #2 sat at a dining table watching TV with other residents. When asked if she remembered anyone grabbing her walker or hurting her she smiled and replied with unintelligible words. There was no signs of anxiety or distress. During an interview on 11/11/23 at 11:57 a.m., LVN A said CNA C came off the secure unit and reported Resident #1 hit Resident #2. She said she went on to the secure unit and Resident #1 and Resident #2 were separated. She assessed Resident #1 and Resident #2 and there was no injuries. She said she reviewed the video and noted Resident #2 was hit on her left hand, left wrist, and left side of her face. Resident #2 was grabbed on her left wrist by Resident #1. She said she was not able to determine how hard Resident #2 was grabbed. Resident #1 had both hands wrapped around Resident #1's wrist and was twisting Resident #2's hands back and forth while grabbing Resident #1's left wrist. Resident #1 and Resident #2 were separated. She said there was no assigned 1 to 1 staff on the secure unit. She said the staff should have called for help when they were providing care to any resident that required two staff. She said all residents were at risk of abuse from Resident #1 when there was no supervision. She said she was retrained on preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors During an interview on 11/11/23 at 12:56 p.m., LVN E said she was the MDS nurse. She said she admitted Resident #1 back to the facility from a behavior hospital on [DATE]. She said Resident #1 was combative with the transport driver. She said she did not want to readmit her to the facility and wanted to send her back to the behavior hospital. She said Resident #1 was sent back to the facility without report. She said the transport driver directed her to call the behavior hospital. She said the behavior hospital said Resident #1's combative and aggressive behavior was her baseline and if she required 1-1 staff then that is what the facility would have to implement. She said she argued with the behavior hospital and said it was not appropriate to send Resident #1 back to the facility. She said she called the NP and was told to send Resident #1 back to the behavior hospital but she could not because it was across state lines. She said she did not assign 1 to 1 staff. She said she did not get a physician order for one to one staff and was waiting for an order. She said other residents were at risk of abuse from Resident #1 if there was not adequate supervision. She said she was retrained on preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors. During an interview on 11/11/23 at 1:15 p.m., the RDO said after the incident with Resident #1 on 11/03/23, the facility held a QAPI on 11/08/23 and developed PIPs related to preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676072 If continuation sheet Page 3 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676072 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corrigan Ltc Nursing & Rehabilitation 300 Hyde St Corrigan, TX 75939 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety resident rights, and dealing with residents with aggressive behaviors. He said the facility started retraining nursing staff on 11/03/23. He said all nursing staff were retrained on preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors. He said all new staff and any staff not trained would be trained by the DON or ADON prior to working their scheduled shift. He said there were no other residents in the facility who were abusive to other residents. Residents Affected - Few During an interview on 11/11/23 at 2:55 p.m., the ADON said Resident #1 was re-admitted to the facility from a behavior hospital. She said Resident #1 was more combative with care and not usually aggressive towards other residents. She said Resident #1 should have been placed on 1-1 when she returned. She said all residents were supposed to be protected from abuse. She said after the incident with Resident #1 on 11/03/23, the facility held a QAPI on 11/08/23 and developed PIPs related to preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors. She said the facility started retraining nursing staff on 11/03/23. She said all staff were retrained on preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors. She said all new staff and any staff not trained would trained by the DON or ADON prior to working their scheduled shift. She said there were no other residents in the facility who were abusive to other residents. During an interview on 11/11/23 at 3:11 p.m. the DON said when Resident #1 was re-admitted to the facility from the behavior hospital on [DATE], the facility should have implemented one to one. She said after the incident with Resident #1 on 11/03/23, the facility held a QAPI on 11/08/23 and developed PIPs related to preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors. She said the facility started retraining nursing staff on 11/03/23. She said all staff were retrained on preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors. She said she (the DON) and the Administrator were responsible to ensure all staff were trained and to monitor to ensure compliance with the QAPI plan/PIP. She said all new staff and any staff not trained would be trained by the DON or ADON prior to working their scheduled shift. She said there were no other residents in the facility who were abusive to other residents. During an interview on 11/14/23 at 2:12 p.m., LVN D said Resident #1 was re-admitted to the facility from a behavior hospital. She said Resident #1 was very combative. She said after CNA C reported Resident #1 hit Resident #2, she went on the secure unit and saw the aides had separated the residents. She said she viewed the incident on the video and saw Resident #2 was hit on her left hand, left wrist, and left side of her face. Resident #2 was grabbed on her left wrist by Resident #1. Unable to determine how hard Resident #2 was grabbed. Resident #1 had both hands wrapped around Resident #1's wrist and was twisting Resident #2's hands back and forth while grabbing Resident #1's left wrist. Resident #1 and Resident #2 were separated. She said she notified the Administrator, the DON, the physician and Resident #1's family member. She said the residents were assessed and had no injuries. She said she was retrained on preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors. Record review of facility policy Preventing Resident Abuse dated 2001 indicated 1. The facility's goal is to achieve and maintain an abuse-free environment. 2. Our abuse prevention/intervention program includes but is not limited to, the following: . g. Training staff to understand and manage a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676072 If continuation sheet Page 4 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676072 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corrigan Ltc Nursing & Rehabilitation 300 Hyde St Corrigan, TX 75939 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few resident's verbal or physical aggression; . j. Assessing, care planning and monitoring residents with needs and behaviors that may lead to conflict or neglect; k. Assessing residents with signs and symptoms of behavior problems and developing and implementing care plans to address behavioral issues; . striving to maintain adequate staffing on all shifts to ensure that needs of each resident are met; . Record review of the facility's Abuse, Neglect, Exploitation and Misappropriation Prevention Program dated 2001 indicated Residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. This included but is not limited to freedom from corporal punishment, involuntary seclusion verbal, mental, sexual, or physical abuse and physical or chemical restraint not required to treat the resident's symptoms. The resident abuse, neglect and exploitation prevention or misappropriation of property by anyone including, but not necessarily limited to: a. facility staff; other residents; . On 11/14/23, the surveyor confirmed the facility implemented appropriate measures to ensure the safety of residents after the incident on 11/03/23 involving Resident #1 and Resident #2 by: Review of QAPI notes dated 11/08/23 showed a meeting was held to discuss the incident with Resident #1 and Resident #2 on 11/03/23. Members present included the Administrator, DON, Medical Director, MDS Coordinator, and ADON. The interventions and plan for correction included : -obtaining emergency physician orders -resident to resident altercations -resident rights -discharge and IDT communication -abuse and neglect prevention and staff training Record review of the staff in-services dated 11/03/23 through 11/11/23 included: -obtaining emergency physician orders, -resident to resident altercations, -resident rights, -discharge and IDT communication, and -abuse and neglect prevention and staff training. During interviews on 11/11/23 9:30 a.m. through 4:00 p.m., and 11/14/23 from 9:30 a.m. through 2:20 p.m., 5 LVN's (on all shifts) 10 CNA's (on all shifts) and the ADON said they received training prior to the incident and after the incident on 11/03/23 from the Administrator or the DON regarding resident abuse, neglect, rights, dealing with residents with aggressive behaviors and resident supervision levels. The nursing staff verbalized understanding of the trainings and were able to give examples of dealing with behaviors and preventing abuse. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676072 If continuation sheet Page 5 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676072 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corrigan Ltc Nursing & Rehabilitation 300 Hyde St Corrigan, TX 75939 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 The noncompliance was identified as PNC. The immediate jeopardy (IJ) began on 11/03/23 and ended on 11/08/23. The facility had corrected the noncompliance before the survey began. Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676072 If continuation sheet Page 6 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676072 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corrigan Ltc Nursing & Rehabilitation 300 Hyde St Corrigan, TX 75939 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to implement policy to ensure the rights of residents to be free from abuse for 1 of 6 residents (Resident #2) reviewed for abuse. Residents Affected - Few The facility failed to prevent Resident #1 from grabbing, hitting and slapping Resident #2 on 11/03/23. The noncompliance was identified as PNC. The immediate jeopardy (IJ) began on 11/03/23 and ended on 11/08/23. The facility had corrected the noncompliance before the survey began. The failure could place residents at risk for abuse, intimidation, fear, agitation, and decreased quality of life. Findings included: Record review of the facility's Abuse, Neglect, Exploitation and Misappropriation Prevention Program dated 2001 indicated Residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. This included but is not limited to freedom from corporal punishment, involuntary seclusion verbal, mental, sexual, or physical abuse and physical or chemical restraint not required to treat the resident's symptoms. The resident abuse, neglect and exploitation prevention or misappropriation of property by anyone including, but not necessarily limited to: a. facility staff; other residents; . Record review of facility policy Preventing Resident Abuse dated 2001 indicated 1. The facility's goal is to achieve and maintain an abuse-free environment. 2. Our abuse prevention/intervention program includes but is not limited to, the following: . g. Training staff to understand and manage a resident's verbal or physical aggression; . j. Assessing, care planning and monitoring residents with needs and behaviors that may lead to conflict or neglect; k. Assessing residents with signs and symptoms of behavior problems and developing and implementing care plans to address behavioral issues; . striving to maintain adequate staffing on all shifts to ensure that needs of each resident are met; . Record review of Resident #1's face sheet indicated she was a [AGE] year old female admitted on [DATE] and her diagnoses included Alzheimer's (a progressive disease beginning with mild memory loss and possibly leading to loss of the ability to carry on a conversation and respond to the environment), dementia (impaired ability to remember, think, or make decisions that interferes with doing everyday activities) with behavioral disturbance, psychotic disorder (serious illness that affect the mind) with delusions (a belief that is clearly false and that indicates an abnormality in the affected person's content of thought), and anxiety (a feeling of fear, dread, and uneasiness). Record review of Resident #1's MDS dated [DATE] indicated she was usually able to make herself understood and usually understood others. She had severe cognitive impairment (BIMS score of 3). She had physical behaviors directed at others. Record review of Resident #1's care plan dated 07/12/23 (revised 08/29/23) indicated Resident #1 has attempted and hit other residents. Interventions included assess and anticipate Resident #1's needs. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676072 If continuation sheet Page 7 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676072 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corrigan Ltc Nursing & Rehabilitation 300 Hyde St Corrigan, TX 75939 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Record review of Resident #2's face sheet indicated she was an [AGE] year old female, admitted on [DATE], and her diagnoses included Alzheimer's, schizoaffective disorder (a mental illness that can affect your thoughts, mood and behavior) depressive type, and cognitive communication deficit (difficulty with thinking and how someone uses language). Record review of Resident #2's MDS dated [DATE] indicated she was usually understood and sometimes understands others. She had severe cognitive impairment (BIMS score of 5). She had hallucinations and delusions. There were no behaviors directed at others. Record review of progress note dated 10/31/23 at 1:50 p.m., completed by LVN E (MDS) indicated Resident #1 was on secure unit. She was hitting, slapping, and pinching staff. LVN E spoke with staff at behavior hospital who said Resident #1 was at base line of needing one on one care with aggressive behaviors. The physician was notified and waiting for orders. Record review of a progress noted dated 11/03/23 at 7:29 p.m., completed by LVN A indicated Resident #1 attempted to pull walker away from Resident #2. Resident #1 hit Resident #2 on the top of her left hand, on her left wrist, and on the left side of her face. Resident #1 separated from Resident #2 and monitored one on one. Record review of a progress note dated 11/03/23 at 11:45 p.m., completed by LVN B indicated Resident #1's family member was notified of Resident #1's behaviors. Resident #1 was transported by the facility and discharged home at approximately 11:30 p.m. Record review of Resident #1's incident report dated 11/03/23 at 11:00 p.m. , completed by LVN A indicated Resident #1 attempted to pull Resident #2's walker away from her. When Resident #1 was not able to pull the walker away from Resident #2, Resident #1 hit Resident #2 on the top of her left hand, on her left wrist, and on the left side of her face. CNA C walked into the dining room while Resident #1 and Resident #2 were standing close together with arms locked. CNA C separated Resident #1 and Resident #2. Resident #2 hit CNA C. Residents #1 and Resident #2 were separated. Resident #1 placed on one to one monitoring. The DON, Administrator, RP, and MD were notified. Hospice was notified. There were no observed injuries. Record review of Resident #2's incident report dated 11/11/23 at 11:00 p.m., completed by LVN A indicated Resident #2 was hit on her left hand, left wrist, and left side of her face. Resident #2 said, She hit me. Did you see her? Resident #2 was grabbed on her left wrist by Resident #1. Unable to determine how hard Resident #2 was grabbed. Resident #1 had both hands wrapped around Resident #1's wrist and was twisting Resident #2's hands back and forth while grabbing Resident #1's left wrist. Resident #1 and Resident #2 were separated. Resident #2 denied any pain. No distress noted. No bruising, [NAME], discoloration, or anything abnormal noted to Resident #2's left hand, wrist or face. No signs of pain noted upon passive ROM to LUE. Physician, DON, Administrator, and guardian notified. The surveyor requested to observe the video of the incident on 11/03/23. The facility was not able to provide access to the video because the system did not retain a copy. During an interview on 11/11/23 at 9:35 a.m., the Administrator said she was the abuse coordinator. She said Resident #1 resided on the secure unit. She said Resident #1 had a history of aggression towards staff and residents. She said the other residents were afraid of Resident #1. She said there were two CNAs on the secure unit when the incident occurred. She said staff were supposed to supervise and monitor Resident #1 but left her alone to provide care for another resident. Staff should (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676072 If continuation sheet Page 8 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676072 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corrigan Ltc Nursing & Rehabilitation 300 Hyde St Corrigan, TX 75939 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few have called for the nurse to provide the supervision when they were not able to supervise Resident #1. She said all staff were at risk of abuse from Resident #1 when there was no supervision. She said after the incident with Resident #1 on 11/03/23, the facility held a QAPI on 11/08/23 and developed PIPs related to preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors. She said the facility started retraining nursing staff on 11/03/23. She said all nursing staff were retrained on preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors. She said all new staff and any staff not trained would be trained by the DON or ADON prior to working their scheduled shift. She said there were no other residents in the facility who were abusive to other residents. She said she (the Administrator) and the DON were responsible to ensure all staff were trained and to monitor to ensure compliance with the QAPI plan/PIP. During observation and interview on 11/11/23 at 10:25 a.m., Resident #2 sat at a dining table watching TV with other residents. When asked if she remembered anyone grabbing her walker or hurting her she smiled and replied with unintelligible words. There was no signs of anxiety or distress. During an interview on 11/11/23 at 11:57 a.m., LVN A said CNA C came off the secure unit and reported Resident #1 hit Resident #2. She said she went on to the secure unit and Resident #1 and Resident #2 were separated. She assessed Resident #1 and Resident #2 and there was no injuries. She said she reviewed the video and noted Resident #2 was hit on her left hand, left wrist, and left side of her face. Resident #2 was grabbed on her left wrist by Resident #1. She said she was not able to determine how hard Resident #2 was grabbed. Resident #1 had both hands wrapped around Resident #1's wrist and was twisting Resident #2's hands back and forth while grabbing Resident #1's left wrist. Resident #1 and Resident #2 were separated. She said there was no assigned 1 to 1 staff on the secure unit. She said the staff should have called for help when they were providing care to any resident that required two staff. She said all residents were at risk of abuse from Resident #1 when there was no supervision. She said she was retrained on preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors During an interview on 11/11/23 at 12:56 p.m., LVN E said she was the MDS nurse. She said she admitted Resident #1 back to the facility from a behavior hospital on [DATE]. She said Resident #1 was combative with the transport driver. She said she did not want to readmit her to the facility and wanted to send her back to the behavior hospital. She said Resident #1 was sent back to the facility without report. She said the transport driver directed her to call the behavior hospital. She said the behavior hospital said Resident #1's combative and aggressive behavior was her baseline and if she required 1-1 staff then that is what the facility would have to implement. She said she argued with the behavior hospital and said it was not appropriate to send Resident #1 back to the facility. She said she called the NP and was told to send Resident #1 back to the behavior hospital but she could not because it was across state lines. She said she did not assign 1 to 1 staff. She said she did not get a physician order for one to one staff and was waiting for an order. She said other residents were at risk of abuse from Resident #1 if there was not adequate supervision. She said she was retrained on preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors. During an interview on 11/11/23 at 1:15 p.m., the RDO said after the incident with Resident #1 on 11/03/23, the facility held a QAPI on 11/08/23 and developed PIPs related to preventing, identifying, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676072 If continuation sheet Page 9 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676072 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corrigan Ltc Nursing & Rehabilitation 300 Hyde St Corrigan, TX 75939 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors. He said the facility started retraining nursing staff on 11/03/23. He said all nursing staff were retrained on preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors. He said all new staff and any staff not trained would be trained by the DON or ADON prior to working their scheduled shift. He said there were no other residents in the facility who were abusive to other residents. During an interview on 11/11/23 at 2:55 p.m., the ADON said Resident #1 was re-admitted to the facility from a behavior hospital. She said Resident #1 was more combative with care and not usually aggressive towards other residents. She said Resident #1 should have been placed on 1-1 when she returned. She said all residents were supposed to be protected from abuse. She said after the incident with Resident #1 on 11/03/23, the facility held a QAPI on 11/08/23 and developed PIPs related to preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors. She said the facility started retraining nursing staff on 11/03/23. She said all staff were retrained on preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors. She said all new staff and any staff not trained would trained by the DON or ADON prior to working their scheduled shift. She said there were no other residents in the facility who were abusive to other residents. During an interview on 11/11/23 at 3:11 p.m. the DON said when Resident #1 was re-admitted to the facility from the behavior hospital on [DATE], the facility should have implemented one to one. She said after the incident with Resident #1 on 11/03/23, the facility held a QAPI on 11/08/23 and developed PIPs related to preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors. She said the facility started retraining nursing staff on 11/03/23. She said all staff were retrained on preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors. She said she (the DON) and the Administrator were responsible to ensure all staff were trained and to monitor to ensure compliance with the QAPI plan/PIP. She said all new staff and any staff not trained would be trained by the DON or ADON prior to working their scheduled shift. She said there were no other residents in the facility who were abusive to other residents. During an interview on 11/14/23 at 2:12 p.m., LVN D said Resident #1 was re-admitted to the facility from a behavior hospital. She said Resident #1 was very combative. She said after CNA C reported Resident #1 hit Resident #2, she went on the secure unit and saw the aides had separated the residents. She said she viewed the incident on the video and saw Resident #2 was hit on her left hand, left wrist, and left side of her face. Resident #2 was grabbed on her left wrist by Resident #1. Unable to determine how hard Resident #2 was grabbed. Resident #1 had both hands wrapped around Resident #1's wrist and was twisting Resident #2's hands back and forth while grabbing Resident #1's left wrist. Resident #1 and Resident #2 were separated. She said she notified the Administrator, the DON, the physician and Resident #1's family member. She said the residents were assessed and had no injuries. She said she was retrained on preventing, identifying, and reporting resident abuse and neglect, physician orders, resident to resident altercations, resident rights, and dealing with residents with aggressive behaviors. On 11/14/23, the surveyor confirmed the facility implemented appropriate measures to ensure the safety of residents after the incident on 11/03/23 involving Resident #1 and Resident #2 by: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676072 If continuation sheet Page 10 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676072 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corrigan Ltc Nursing & Rehabilitation 300 Hyde St Corrigan, TX 75939 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Review of QAPI notes dated 11/08/23 showed a meeting was held to discuss the incident with Resident #1 and Resident #2 on 11/03/23. Members present included the Administrator, DON, Medical Director, MDS Coordinator, and ADON. The interventions and plan for correction included : -obtaining emergency physician orders -resident to resident altercations -resident rights -discharge and IDT communication -abuse and neglect prevention and staff training Record review of the staff in-services dated 11/03/23 through 11/11/23 included: -obtaining emergency physician orders, -resident to resident altercations, -resident rights, -discharge and IDT communication, and -abuse and neglect prevention and staff training. During interviews on 11/11/23 9:30 a.m. through 4:00 p.m., and 11/14/23 from 9:30 a.m. through 2:20 p.m., 5 LVN's (on all shifts) 10 CNA's (on all shifts) and the ADON said they received training prior to the incident and after the incident on 11/03/23 from the Administrator or the DON regarding resident abuse, neglect, rights, dealing with residents with aggressive behaviors and resident supervision levels. The nursing staff verbalized understanding of the trainings and were able to give examples of dealing with behaviors and preventing abuse. The noncompliance was identified as PNC. The immediate jeopardy (IJ) began on 11/03/23 and ended on 11/08/23. The facility had corrected the noncompliance before the survey began. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676072 If continuation sheet Page 11 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676072 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corrigan Ltc Nursing & Rehabilitation 300 Hyde St Corrigan, TX 75939 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure a discharge was appropriately communicated and documented in the medical record for 1 of 1 discharged resident (Resident #1) reviewed for discharge requirements. The facility discharged Resident #1 to home on [DATE]. Resident #1's clinical record had no physician documentation to address why resident was being discharged , what needs of the resident the facility could not meet, and how the resident posed a danger to the existing resident population. The noncompliance was identified as PNC. The noncompliance began on 11/03/23 and ended on 11/08/23. The facility had corrected the noncompliance before the survey began. This failure could place residents at risk for inappropriate discharge from the facility. Findings included: Record review of Resident #1's face sheet indicated she was a [AGE] year old female admitted on [DATE] and her diagnoses included Alzheimer's (a progressive disease beginning with mild memory loss and possibly leading to loss of the ability to carry on a conversation and respond to the environment), dementia (impaired ability to remember, think, or make decisions that interferes with doing everyday activities) with behavioral disturbance, psychotic disorder (serious illness that affect the mind) with delusions (a belief that is clearly false and that indicates an abnormality in the affected person's content of thought), and anxiety (a feeling of fear, dread, and uneasiness). Record review of Resident #1's MDS dated [DATE] indicated she was usually able to make herself understood and usually understood others. She had severe cognitive impairment (BIMS score of 3). She had physical behaviors directed at others. Record review of Resident #1's care plan dated 07/12/23 (revised 08/29/23) indicated Resident #1 has attempted and hit other residents. Interventions included assess and anticipate Resident #1's needs. Record review of Resident #2's face sheet indicated she was an [AGE] year old female, admitted on [DATE], and her diagnoses included Alzheimer's, schizoaffective disorder (a mental illness that can affect your thoughts, mood and behavior) depressive type, and cognitive communication deficit (difficulty with thinking and how someone uses language). Record review of Resident #2's MDS dated [DATE] indicated she was usually understood and sometimes understands others. She had severe cognitive impairment (BIMS score of 5). She had hallucinations and delusions. There were no behaviors directed at others. Record review of progress note dated 10/31/23 at 1:50 p.m., completed by LVN E (MDS) indicated Resident #1 was on secure unit. She was hitting, slapping, and pinching staff. LVN E spoke with staff at behavior hospital who said Resident #1 was at base line of needing one on one care with aggressive behaviors. The physician was notified and waiting for orders. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676072 If continuation sheet Page 12 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676072 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corrigan Ltc Nursing & Rehabilitation 300 Hyde St Corrigan, TX 75939 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of a progress noted dated 11/03/23 at 7:29 p.m., completed by LVN A indicated Resident #1 attempted to pull walker away from Resident #2. Resident #1 hit Resident #2 on the top of her left hand, on her left wrist, and on the left side of her face. Resident #1 separated from Resident #2 and monitored one on one. Record review of a progress note dated 11/03/23 at 11:45 p.m., completed by LVN B indicated Resident #1's family member was notified of Resident #1's behaviors. Resident #1 was transported by the facility and discharged home at approximately 11:30 p.m. Record review of Resident #1's incident report dated 11/03/23 at 11:00 p.m. , completed by LVN A indicated Resident #1 attempted to pull Resident #2's walker away from her. When Resident #1 was not able to pull the walker away from Resident #2, Resident #1 hit Resident #2 on the top of her left hand, on her left wrist, and on the left side of her face. CNA C walked into the dining room while Resident #1 and Resident #2 were standing close together with arms locked. CNA C separated Resident #1 and Resident #2. Resident #2 hit CNA C. Residents #1 and Resident #2 were separated. Resident #1 placed on one to one monitoring. The DON, Administrator, RP, and MD were notified. Hospice was notified. There were no observed injuries. Record review of Resident #2's incident report dated 11/11/23 at 11:00 p.m., completed by LVN A indicated Resident #2 was hit on her left hand, left wrist, and left side of her face. Resident #2 said, She hit me. Did you see her? Resident #2 was grabbed on her left wrist by Resident #1. Unable to determine how hard Resident #2 was grabbed. Resident #1 had both hands wrapped around Resident #1's wrist and was twisting Resident #2's hands back and forth while grabbing Resident #1's left wrist. Resident #1 and Resident #2 were separated. Resident #2 denied any pain. No distress noted. No bruising, [NAME], discoloration, or anything abnormal noted to Resident #2's left hand, wrist or face. No signs of pain noted upon passive ROM to LUE. Physician, DON, Administrator, and guardian notified. During an interview on 11/11/23 at 9:35 a.m., the Administrator said Resident #1 resided on the secure unit. She said Resident #1 had a history of aggression towards staff and residents. She said the other residents were afraid of Resident #1. She said she discharged Resident #1 to her family member on 11/03/23 because of her aggressive behaviors. She said the physician was contacted regarding the incident but was not contacted regarding a discharge order. She said the facility was not able to provide one to one staff. She said after the incident with Resident #1 on 11/03/23, the facility held a QAPI on 11/08/23 and developed PIPs related to discharges. She said she was inserviced on 11/08/23 regarding the facility's discharge policy. She said she understood all resident discharges should be completed per facility policy and regulations (federal and state) to ensure safe discharges. During an interview on 11/11/23 at 11:23 a.m., Resident #1's family member said he received a call from the facility on 11/03/23 regarding Resident #1's aggression towards other residents. He said he was told the facility would discharge Resident #1 home due to her behaviors. He said he asked what he could do about it and then told the facility to bring Resident #1 to him (at his home). He said she arrived late and kept her at home until the following Monday. He said she attacked him and bit him. He said the hospice staff came to his home and ordered she be taken to the hospital. He said Resident #1 would remain in the hospital until suitable placement was found. He said he did not recall and did not receive a 30 day discharge notification. During an interview on 11/11/23 at 11:57 a.m., LVN A said she received a call from the administrator and was informed the facility was going to discharge Resident #1 back to her family member. She said Resident #1 was previously given a 30-day discharge but it was a week earlier than the discharge (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676072 If continuation sheet Page 13 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676072 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corrigan Ltc Nursing & Rehabilitation 300 Hyde St Corrigan, TX 75939 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few date of 11/10/23. She said LVN D called Resident #1's family member and he did not agree with the discharge. He was crying and said he needed more days to find a place for her. He said he had just got out of the hospital and was not able to care for Resident #1. She said she told the Administrator what Resident #1's family member said and the Administrator said she would call him. She said the Administrator said she spoke with Resident #1's family member and the family member agreed to take her back. The facility did not have any doctor orders for the discharge. She asked the Administrator why the facility couldn't send Resident #1 to the ER and the Administrator said she would take care of the doctor's order for discharge. She said after the incident with Resident #1 on 11/03/23, the facility started retraining nursing staff on 11/03/23. She said she was retrained on discharges and the facility's discharge policy. She said Resident #1's discharge was not done per facility protocol. During an interview on 11/11/23 at 12:56 p.m., LVN E said after the incident with Resident #1 on 11/03/23, the facility retrained staff on discharges and the facility's discharge policy. She said Resident #1's discharge was not done per facility protocol. During an interview on 11/11/23 at 1:15 p.m., the RDO said after the incident with Resident #1 on 11/03/23, the facility held a QAPI on 11/08/23 and developed PIPs related to discharges. He said Resident #1's discharge was not done per facility protocol. He said the Administrator was trying to protect the other residents. He said she was inserviced on 11/08/23 and retrained on the facility's discharge policy. During an interview on 11/11/23 at 2:55 p.m., the ADON said after the incident with Resident #1 on 11/03/23, the facility held a QAPI on 11/08/23 and developed PIPs related to discharges. She said the facility retrained on nursing staff on discharges and their policy. She said Resident #1's discharge was not done per facility protocol. During an interview on 11/11/23 at 3:11 p.m. the DON said the Administrator completed Resident #1's discharge. She said the facility contacted the physician about the incident on 11/03/23 but did not obtain a discharge order. She said after the incident with Resident #1 on 11/03/23, the facility held a QAPI on 11/08/23 and developed PIPs related to discharges. She said she (the DON) and the Administrator were responsible to ensure all staff were trained and to monitor to ensure compliance with the QAPI plan/PIP. She said all new staff and any staff not trained would be trained by herself or ADON prior to working their scheduled shift. She said there were no other residents in the facility who were emergency discharged or given a 30 day discharge notice. She said Resident #1's discharge was not done per facility protocol. During an interview on 11/14/23 at 2:12 p.m., LVN D said she notified the Administrator, the DON, the physician and Resident #1's family member on 11/03/23 after Resident #1 assaulted Resident #2. She said the Administrator returned the call and said Resident #1 would be discharged . She said she was going to get an order but did not get the order because the facility was undecided about the discharge. She said the regional staff indicated the facility was able to discharge Resident #1 if her family member agreed and there was two witnesses. Resident #1's family member asked if the facility could not handle her how could he because he was sick. She said Resident #1's family member did not give permission to discharge her back to him. She said the Administrator said she would call Resident #1's family member and when she arrived at the facility she said Resident #1's family member said he agreed to the discharge. She said she did not receive a physician order for Resident #1's discharge. She said after the incident with Resident #1 on 11/03/23, the facility retrained nursing staff on discharges and the facility's discharge policy. She said Resident #1's discharge was not done per facility protocol. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676072 If continuation sheet Page 14 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676072 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corrigan Ltc Nursing & Rehabilitation 300 Hyde St Corrigan, TX 75939 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of the Discharge Notice dated 10/11/23 and sent via certified mail on 10/13/23 (per receipt date) indicated Resident #1 was discharged due to unable to continue the one-on-one sitter effective 11/10/23. Record review of the facility's Discharge Policy dated 2001 (revised 2016) indicated: . 4. When a resident is transferred or discharged from the facility, the following information will be documented in the medical record: a. The basis for the transfer or discharge; (1) If the resident is being transferred or discharged because his or her needs cannot be met at the facility, documentation will include: (a) the specific resident needs that cannot be met; (b) this facility's attempt to meet those needs; and (c) the receiving facility's service(s) that are available to meet those needs. b. That an appropriate notice was provided to the resident and/or legal representative; c. The date and time of the transfer or discharge; d. The new location of the resident; e. The mode of transportation; f. A summary of the resident's overall medical, physical, and mental condition; g. Disposition of personal effects; h. Disposition of medications; i. Others as appropriate or as necessary; and j. The signature of the person recording the data in the medical record. 6. Should the resident be transferred or discharged for any of the following reasons, the basis for the transfer or discharge will be documented in the resident's clinical record by a physician: a. The safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident; or b. The health of individuals in the facility would otherwise be endangered. On 11/14/23, the surveyor confirmed the facility implemented appropriate measures to ensure the proper discharge of residents after the incident on 11/03/23 involving Resident #1 by: Review of QAPI notes dated 11/08/23 showed a meeting was held to discuss the incident with Resident #1 and Resident #2 on 11/03/23. Members present included the Administrator, DON, Medical Director, MDS Coordinator, and ADON. The interventions and plan for correction included obtaining emergency physician orders and discharge and IDT communication. Record review of the staff in-services dated 11/03/23 through 11/11/23 included: -obtaining emergency physician orders, -resident rights, and -discharge and IDT communication. During interviews on 11/11/23 9:30 a.m. through 4:00 p.m., and 11/14/23 from 9:30 a.m. through 2:20 p.m., 5 LVN's (on all shifts), the ADON, the DON, and the Administrator said they received training prior to the incident and after the incident on 11/03/23 from the Administrator or the DON regarding resident discharges. The nursing staff verbalized understanding of the trainings. The noncompliance was identified as PNC. The noncompliance began on 11/03/23 and ended on 11/08/23. The facility had corrected the noncompliance before the survey began. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676072 If continuation sheet Page 15 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676072 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corrigan Ltc Nursing & Rehabilitation 300 Hyde St Corrigan, TX 75939 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for 1 of 6 residents (Resident #1) reviewed for care plans. The facility failed to ensure Resident #1's care plan included supervision and interventions after she returned to the facility from a behavioral hospital with continued aggressive behaviors on 10/31/23. Resident #1's care plan did not include discharge plans for 11/03/23. This failure could place residents at risk of being physically assaulted due to lack of appropriate interventions in place. Findings included: Record review of Resident #1's face sheet indicated she was a [AGE] year old female admitted on [DATE] and her diagnoses included Alzheimer's (a progressive disease beginning with mild memory loss and possibly leading to loss of the ability to carry on a conversation and respond to the environment), dementia (impaired ability to remember, think, or make decisions that interferes with doing everyday activities) with behavioral disturbance, psychotic disorder (serious illness that affect the mind) with delusions (a belief that is clearly false and that indicates an abnormality in the affected person's content of thought), and anxiety (a feeling of fear, dread, and uneasiness). Record review of Resident #1's MDS dated [DATE] indicated she was usually able to make herself understood and usually understood others. She had severe cognitive impairment (BIMS score of 3). She had physical behaviors directed at others. Record review of Resident #1's care plan dated 07/12/23 (revised 08/29/23) indicated Resident #1 has attempted and hit other residents. Interventions included assess and anticipate Resident #1's needs. Record review of Resident #2's face sheet indicated she was an [AGE] year old female, admitted on [DATE], and her diagnoses included Alzheimer's, schizoaffective disorder (a mental illness that can affect your thoughts, mood and behavior) depressive type, and cognitive communication deficit (difficulty with thinking and how someone uses language). Record review of Resident #2's MDS dated [DATE] indicated she was usually understood and sometimes understands others. She had severe cognitive impairment (BIMS score of 5). She had hallucinations and delusions. There were no behaviors directed at others. Record review of progress note dated 10/31/23 at 1:50 p.m., completed by LVN E (MDS) indicated Resident #1 was on secure unit. She was hitting, slapping, and pinching staff. LVN E spoke with staff at behavior hospital who said Resident #1 was at base line of needing one on one care with aggressive behaviors. The physician was notified and waiting for orders. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676072 If continuation sheet Page 16 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676072 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corrigan Ltc Nursing & Rehabilitation 300 Hyde St Corrigan, TX 75939 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of a progress noted dated 11/03/23 at 7:29 p.m., completed by LVN A indicated Resident #1 attempted to pull walker away from Resident #2. Resident #1 hit Resident #2 on the top of her left hand, on her left wrist, and on the left side of her face. Resident #1 separated from Resident #2 and monitored one on one. Record review of a progress note dated 11/03/23 at 11:45 p.m., completed by LVN B indicated Resident #1's family member was notified of Resident #1's behaviors. Resident #1 was transported by the facility and discharged home at approximately 11:30 p.m. Record review of Resident #1's incident report dated 11/03/23 at 11:00 p.m. , completed by LVN A indicated Resident #1 attempted to pull Resident #2's walker away from her. When Resident #1 was not able to pull the walker away from Resident #2, Resident #1 hit Resident #2 on the top of her left hand, on her left wrist, and on the left side of her face. CNA C walked into the dining room while Resident #1 and Resident #2 were standing close together with arms locked. CNA C separated Resident #1 and Resident #2. Resident #2 hit CNA C. Residents #1 and Resident #2 were separated. Resident #1 placed on one to one monitoring. The DON, Administrator, RP, and MD were notified. Hospice was notified. There were no observed injuries. During an interview on 11/11/23 at 9:35 a.m., the Administrator said she said Resident #1 resided on the secure unit. She said Resident #1 had a history of aggression towards staff and residents. She said the other residents were afraid of Resident #1. She said there were two CNAs on the secure unit when the incident occurred. She said staff were supposed supervise and monitor Resident #1 but left her alone to provide care for another resident. Staff should have called for the nurse to provide supervision when they were not able to provide supervision for Resident #1. She said Resident #1's aggressive behaviors should have been addressed in a care plan. She said the care plan should have included level of supervision. She said Resident #1 was re-admitted to the facility on [DATE] from a behavior hospital. She said the behavior hospital indicated Resident #1 needed one to one supervision. She said the facility sent a 30 day discharge notice to Resident #1's family member on 10/11/23 due to her aggressive behaviors. She said a discharge care plan was not developed. During an interview on 11/11/23 at 11:23 a.m., Resident #1's family member said he received a call from the facility on 11/03/23 regarding Resident #1's aggression towards other residents. He said he was told the facility would discharge Resident #1 home due to her behaviors. He said he asked what he could do about it and then told the facility to bring Resident #1 to him (at his home). He said he did not recall and did not receive a 30-day discharge notification. During an interview on 11/11/23 at 11:57 a.m., LVN A said there was no assigned 1 to 1 staff on the secure unit. She said the staff should have called for help when they were providing care to any resident that required two staff During an interview on 11/11/23 at 12:56 p.m., LVN E said she was the MDS nurse. She said she was responsible for developing the care plans. She said she did not revise Resident #1's care plan regarding supervision after she admitted Resident #1 back to the facility from a behavior hospital on [DATE]. She said Resident #1 was combative with the transport driver. She said she did not want to readmit her to the facility and wanted to send her back to the behavior hospital. She said Resident #1 was sent back to the facility without report. She said the transport driver directed her to call the behavior hospital. She said the behavior hospital said Resident #1's combative and aggressive behavior was her baseline and if she required 1-1 staff then that is what the facility would have to implement. She said a discharge care plan was not developed for Resident #1 prior to the 30 day notice. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676072 If continuation sheet Page 17 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676072 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corrigan Ltc Nursing & Rehabilitation 300 Hyde St Corrigan, TX 75939 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 11/11/23 at 2:55 p.m., the ADON said Resident #1 was re-admitted to the facility from a behavior hospital. She said Resident #1 was more combative with care and not usually aggressive towards other residents. She said Resident #1 should have been placed on 1-1 when she returned and her care plan should have included supervision. During an interview on 11/11/23 at 3:11 p.m. the DON said when Resident #1 was re-admitted to the facility from the behavior hospital on [DATE], the facility should have implemented one to one and developed and implanted her care plan to include supervision. Record review of the facility's Comprehensive Person-Centered Care Plan policy, dated 2001 (revised December 2016), indicated A comprehensive, personalized care plan that includes measurable objectives and timetables to meet the resident's medical, nursing, mental and psychological needs is developed for each resident. .8. The comprehensive care plan will: a. Include measurable objectives and timeframes; b. Describe the services that are to be furnished . g. Incorporate identified problem areas; . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676072 If continuation sheet Page 18 of 18